| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
5,745 |
5,701 |
$265K |
| D0120 |
Periodic oral evaluation - established patient |
3,238 |
3,212 |
$221K |
| D1310 |
|
2,696 |
2,668 |
$121K |
| D1206 |
Topical application of fluoride varnish |
5,707 |
5,664 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,304 |
1,292 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,219 |
4,421 |
$80K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,013 |
515 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
4,609 |
4,561 |
$55K |
| D9993 |
|
738 |
736 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,114 |
1,043 |
$44K |
| D1351 |
Sealant - per tooth |
1,097 |
293 |
$40K |
| D0603 |
|
1,486 |
1,476 |
$22K |
| D0145 |
Oral evaluation for a patient under three years of age |
270 |
269 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
258 |
155 |
$15K |
| D0601 |
|
852 |
848 |
$13K |
| D0350 |
|
1,149 |
524 |
$11K |
| D9430 |
|
258 |
254 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
151 |
81 |
$7K |
| D1354 |
|
377 |
124 |
$3K |
| D0272 |
Bitewings - two radiographic images |
22 |
22 |
$264.00 |
| D0274 |
Bitewings - four radiographic images |
12 |
12 |
$259.20 |